The role of surgery in the treatment of primary gastric lymphoma.

The present retrospective study of 23 patients with primary gastric lymphoma had the objective of determining the role of surgical treatment on survival. All patients were submitted to gastric resection with regional lymph node removal. Nine patients (39.1%) received supplementary treatment (chemotherapy and/or radiotherapy). According to the Kiel classification, the most frequent histological type was the centroblastic (29.1%), and most patients (60.9%) had a low-grade lymphoma. According to the Ann Arbor classification, modified by Musshoff and Schmidt-Vollmer, stages were IE in 52.1%, II1E in 8.7%, II2E in 13.1%, and IV in 26.1% of the cases. Mean survival was 29.3 months. The variables that influenced survival rates were age, advanced stage tumor, and receiving postoperative adjuvant therapy. Analysis of our cases suggests that complete lesion resection along with adjacent lymph nodes, and supplementary postoperative treatment is the best approach for a resectable primary gastric lymphoma.

Restaging of colorectal cancer based on the identification of lymph node micrometastases through immunoperoxidase staining of CEA and cytokeratins.

The present study was performed to identify tumor cells in lymph nodes from colorectal adenocarcinomas considered free of disease by the classic hematoxylin-eosin stain, based on the detection of the carcinoembryonic antigen (CEA) and cytokeratins in neoplastic epithelial cells. For this purpose, 603 lymph nodes from 46 lesions were stained by the peroxidase-antiperoxidase technique. Tumor cells were detected in 22 nodes from 12 patients, mainly in the subcapsular sinuses, permitting a restaging of these patients into two groups: those now considered to have metastatic disease and those free of metastases. However, the 5-year follow-up showed no statistical differences in survival between the two groups.

[Effects of parenteral nutrition on tumor growth: experimental aspects]. / Efeitos da nutrição parenteral sobre o desenvolvimento tumoral: aspectos experimentais.

There still exist controversies about the effect of parenteral nutrition on cancer growth. For elucidation of this question the development of Walker 256 carcinosarcoma in rats submitted to parenteral nutrition (PN) was studied. Thirty-five Wistar rats were randomly distributed in three groups: OT group (11), tumor-bearing animals always under oral feeding for 14 days; PC group (14), tumor free animals under PN for 7 days; PT group (10), tumor-bearing rats under PT for 7 days. PT solution contained 15% glucose, 3% aminoacids and essential micronutrients. Body and tumor weight (in OT and PT groups) were evaluated daily. Carcass weight was obtained by the difference between the body and tumor weight. The rats of the PC group had an initial body weight loss that became stabilized afterwards at a lower plateau level. The rats of the PT group also presented an initial body weight loss recovered progressively afterwards. This difference is probably due to tumor mass expansion in PT animals, since PT rats carcass weight remained similar to that of body weight in PC group. The tumor growth has shown no difference between the oral and parenteral feeding groups, particularly when tumor weight/carcass weight ratio was considered. It is concluded that parenteral nutrition does not favor tumor growth in detriment to carcass weight development.

An experimental study of the impact of cancer on nitrogen metabolism and wound healing.

In Wistar rats bearing a Walker-256 carcinoma flank tumor, a standard skin wound was inflicted on the backs of the animals. Nitrogen intake and nitrogen balance measures were obtained. The standard wound did not promote tumor growth. Wound contraction in tumor-bearing animals was not different from that in tumor-free animals. Tumor-bearing rats had anorexia, lower nitrogen intake and a tendency to lower their nitrogen balance. These findings suggest that both cancer and wound healing are privileged metabolic events, having as a consequence sacrifice of the host.

[Body composition changes in cancer: an experimental study]. / Alterações da composição corpórea no câncer: estudo experimental.

With the aim to study body composition changes in tumor bearing rats submitted to different nutritional conditions, Wistar rats were separated in three diet groups: regular chow, aproteic diet and regular chow after three weeks of aproteic diet. Afterwards the animals were divided in two subgroups: Waler 256 carcinossarcoma bearing rats and tumor free controls. After the sacrifice body composition measurements by the carcass analysis method were performed. Tumor bearing rats presented significant waste of total body fat, body cell mass and increase of Na/K ratio without relation to the nutritional regimen. From this data we conclude that Walker 256 carcinosarcoma causes protein caloric malnutrition even in already depleted rats. After adequate refeeding, body composition rebuilding was obtained in tumor bearing malnourished rats.

[Influences of antitumoral chemotherapy on body composition and nitrogen balance: experimental study]. / Conseqüências da quimioterapia antitumoral sobre a composição corpórea e o balanço nitrogenado: estudo experimental.

An experimental study was carried out with the purpose to examine the 4-epidoxorubicine (4-EPI) action on malignant tumor development and its repercussion on nutritional conditions of the host. Cancer and chemotherapy can generate malnutrition. In order to study the nutritional repercussions, 48 host Wistar rats were divided into 5 groups: Group C: 12 control rats; Group T: 5 rats bearing Walker-256 carcinosarcoma; Group TE: 11 rats given 4-epidoxorubicine (4-EPI) EV simultaneously with tumor implantation; Group T6E: 8 rats given 4-EPI 6 days after the tumor implantation; Group E: 11 rats given only 4-EPI. Tumor and carcass weight and nitrogen balance (by measuring total nitrogen ingested and excreted) were determined daily; the animals were sacrificed on the 20th day of the experiment and material was collected for determination of body composition parameters. A variance analysis was made and the differences were considered to be significative at p less than 0.05. A loss of food during a period following the 4-EPI injection was reflected by carcass weight loss. The accumulated nitrogen incorporation was lower in Groups TE and T6E in the periods of 0-5 days, 0-14 days, and 0-20 days. As for body composition it was verified that free fat solids and total body fat were reduced in Groups T ant T6E when compared to group C. However, 20 days after the use of 4-EPI there were no significative changes in the body composition. In rats bearing Walker-256-carcinosarcoma 4-EPI was effective.(ABSTRACT TRUNCATED AT 250 WORDS)

[Gastric epithelioid leiomyoma (leiomyoblastoma). Analysis of a case and review of the literature]. / Leiomioma epitelióide gástrico (leiomioblastoma). Análise de um caso e revisão da literatura.

The authors report a case of gastric epithelial leiomyoma (leiomyoblastoma). Macroscopically, such tumors resemble leiomyoma, with a biological behavior between leiomyoma and leiomyosarcoma. A review of the medical literature indicates that gastrointestinal bleeding is the most usual manifestation. Gastrointestinal seriography and endoscopy are the most utilized diagnostic exams. The endoscopic biopsy, many times, is unable to confirm the malignant or benign nature of the tumor. It is emphasized the importance of identifying the potentially malignant tendency of the tumor, indicated, mainly, by histology and mitotic counting. The treatment is surgical and consists of local or gastric resection, according to the neoplastic localization, its extension, infiltration, biological nature and the presence of multiple tumors. In the case reported, the patient was operated in urgency because of hemoperitoneum and the source of bleeding was a neoplastic vessel in the anterior wall of the antrum, which was not resected at that time. Later on, a biopsy of the gastric tumor performed during a routine surgery disclosed the real nature of the disease. Once the histopathological diagnostic was made and its potential malignant evolution detected the patient was re-operated. A partial gastrectomy with removal of the antrum was performed. Now, the patient has been asymptomatic with no evidences of metastasis after 30 months of the diagnostic.

Bacteriologia da bile em afeccoes litiasicas das vias biliares.Associacao clinico-radiologica. / Biliary bacteriology in cholelithiasis. Clinical and radiological aspects

Os autores realizaram estudos bacteriologicos de amostras biliares de 55 pacientes submetidos a cirurgia das vias biliares extra-hepaticas devido a colecistopatias litiasicas cronicas e agudas. Relacionaram dados clinicos e radiologicos pre e intra-operatorios com a presenca de bacteriobilia. Obtiveram taxas de positividade de 34,5% para bacterias aerobias e 20% para anaerobias. A analise estatistica dos dados clinicos e bacteriologicos apresentou significancia com relacao a existencia de ictericia, febre, diagnostico de patologia aguda e colangiografia operatoria anormal.Nao houve associacao com o tempo de historia clinica ou com o achado radiologico pre-operatorio

[Bacteriology of the bile in cholecystopathies. Radiological association]. / Bacteriologia da bile em colecistopatias. Associação radiológica.

A clinicobacteriological survey was undertaken in 55 patients undergoing biliary surgery, because of chronic and acute cholecystitis. Some radiological preoperative and operative aspects were analised in order to detect any relation of these aspects with biliary tract infection. The bile cultures were positive in 34,5% and 20,0% for aerobes an anaerobes microorganisms respectively. The microorganisms most frequently isolated were Escherichia coli, Pseudomonas aeruginosa, Klebsiella, Bacteroides sp and Clostridium sp, as aerobian and anaerobian. The statistical analysis showed significance between the presence of bacteria in the biliary tract and pathological operative cholangiography. It had not significance with the radiological preoperative aspects.

Tratamento cirurgico do cancer colorretal. Valor das provas cutaneas de competencia imunologica na avaliacao prognostica e imunoterapica. / Surgical treatment of colon and rectal cancer.Value of immunologic competence skin tests in the prognostic and immunotherapic evaluation

Os autores analisam o valor de provas de competencia imunologica na avaliacao prognostica e imunoterapica no tratamento cirurgico do cancer colorretal. Foram estudados 76 pacientes, incluidos na classificacao de Dukes: no grupo A, um paciente: no grupo B, 46 pacientes e 29 no grupo C.Todos os doentes submeteram-se a avaliacao de imunidade celular por testes cutaneos de varios antigenos, cujas respostas foram estimadas por pontos. Concluiram os autores que o perfil imunologico celular tem valor prognostico em pacientes do grupo B, o que nao ocorre com os pacientes do grupo C. As respostas foram fracas nos doentes dos grupos A e B, estimulados, melhoraram as respostas e tiveram evolucao superior

Vagotomia troncular no tratamento das ulceras pepticas pos-gastrectomias. / Truncal vagotomy in the treatment of postgastrectomy peptic ulcers

Foram estudados 24 pacientes portadores de ulcera peptica pos-gastrectomia parcial tratados exclusivamente pela vagotomia troncular, usando-se preferencialmente a via toracica como acesso. Os resultados precoces demonstraram ausencia de mortalidade pos-operatoria e morbidade muito reduzida. Os resultados tardios apresentam baixos indices de recidiva ulcerosa e nao exibiram quadros importantes de diarreia, demonstrando, portanto, ser um metodo bastante eficiente e com amplas possibilidades de emprego no tratamento das ulceras pepticas pos-gastrectomias

Uma experiencia de ensino em tecnica cirurgica na Faculdade de Medicina da Universidade de Sao Paulo. / A teaching experience in surgical technic at the University of Sao Paulo Medical School

Os autores analisam inicialmente o sentido de que deve revestir-se o processo educacional, salientando a importancia que assume o planejamento do conteudo e a definicao previa de criterios de avaliacao. Examinam a seguir a evolucao da disciplina MCG-610 - Estagio Hospitalar em Tecnica Cirurgica, do curso de graduacao da Faculdade de Medicina da USP.Verificam que, embora a avaliacao da disciplina pelos estudantes tenha melhorado no periodo considerado, a sistematica de avaliacoes adotada permite entrever uma possivel perda de qualidade no desempenho da disciplina. Outros elementos referentes ao curso medico desenvolvido na instituicao sao tambem analisados

A anti-sepsia das maos no preparo da equipe cirurgica. / Hand asepsis in the preparation of the surgical team

Foi estudada a anti-sepsia pre-operatoria das maos em 30 estudantes preparados em condicoes semelhantes as dos componentes da equipe cirurgica. Para o experimento os estudantes foram divididos em tres grupos: grupo testemunha em que a ecovacao das maos e antebracos era feita exclusivamente om agua e sabao comum; grupo alcool iodado com a anti-sepsia completada com a aplicacao de alcool-iodado e grupo PVPI, em que a escovacao era feita com o uso de solucao de polivinil pirrolidona-iodo (PVPI). Terminada a anti-sepsia vestiam aventais e luvas esterilizados, durante periodos estabelecidos de 30, 60 e 120 minutos, simulando o trabalho operatorio. Antes do inicio da escovacao ao final da anti-sepsia das maos e ao termino dos prazos estabelecidos com o uso da vestimenta cirurgica,eram colhidas amostras na superficie das maos e dedos, para cultura e exame bacteriologicos. Pelos resultados obtidos concluiu-se que a escovacao seguida da aplicacao de alcool-iodado tem o melhor poder anti-septico imediato e a feita com PVPI tem acao mais duradoura, impedindo o retorno dos microrganismos a superficie cutanea. Recomenda-se a anti-sepsia com o uso de povidone principalmente nas cirurgias mais demoradas